San Francisco vs. Philadelphia Substance Abuse

There are numerous American cities that stand out for certain characteristics. Madison, Wisconsin as a great place to bike. Cooperstown, N.Y., for the National Baseball Hall of Fame and Museum. Asbury Park, N.J., as the town where Bruce Springsteen got his start. The list goes on and on. Recently, San Francisco and Philadelphia, on opposite coasts, were characterized as standing out for similar reasons: the devasting consequences of addiction.

In San Francisco, for example, an area of Hyde Street has “an open-air narcotics market by day and at night is occupied by the unsheltered and drug-addled slumped on the sidewalk.” Twitter, the article notes, is only a 15-minute walk from there, and other giants of the technology industry are not far away. (Note that the previous blog post dealt with substance abuse in Silicon Valley, not far from the San Francisco area in this post.)

San Francisco’s “persistent homelessness” is a big problem for such wealth so close to it, and a large part of the homeless are the drug dependent. There are hundreds upon hundreds of heroin needles lying around, along with the people who shoot up. The dealers and users are known as “the street people,” or the street population. One resident said it’s like “the land of the living dead” and accuses the city of allowing a containment zone so that the devastation doesn’t spread. The police say the drug trade is their most significant issue.

The problem is so dire that in August, San Francisco health workers walked the streets to find opioid users and offer them Suboxone prescriptions, according to another article. The recipients can get the medication the same day. “At the end of a recent yearlong pilot, about 20 of the 95 participants were still taking buprenorphine under the care of the street medicine team.”

It’s estimated that 22,500 people “actively inject drugs,” and the San Francisco medical director said there’s a strong trend of people using both meth and opioids in the city, which is really difficult to treat. But the goal of going to the streets to find users is to reduce the number of deaths.

Almost three thousand miles away, Philadelphia is known far and wide as “the largest open-air narcotics market for heroin on the East Coast” and so it draws people from “all over,” according to an article that appeared in the New York Times magazine last October. In one neighborhood known as Kensington, which actually takes in other areas as well, dealers hand out free samples with impunity and those on drugs are using them in the open or are already passed out. It’s known as the Badlands and supposedly has the purest heroin in a three-state area.

The author rode through the area in 2017 with a special agent with the D.E.A. According to her description, it looks like the apocalypse hit there – “Houses transformed into drug dens, factories into spaces to shoot up, rail yards into homeless encampments.” Sadly, the largest provider of drug treatment programs in the Bay Area is the prison system.

There’s history behind why this neighborhood is the way it is, starting with the fact that it had cheap housing, and once people moved in and a drug haven started springing up around them, they didn’t have the money to leave. That story, and the individual stories, go on and on, and it’s just so sad. Kind of like San Francisco. Last January the governor signed a statewide disaster declaration—a public health emergency—to take concrete steps to try and address the devastation.

In the comments that appeared after the article, a San Francisco resident wrote in to say, “The article has allowed me to see how intractable our own ‘homeless’ problem in San Francisco will be without first addressing the drug epidemic….[It] shows what a death sentence heroin is, both for the users and for the community that the users (and pushers) inhabit. Why do we as a civilized, supposedly advanced society allow this?”.

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